Calcificaciones esclerocoroideas asociadas a hipovitaminosis D / Sclerochoroidal calcification associated with hypovitaminosis D

CASO CLÍNICO: Mujer de 69 años que presenta en una exploración funduscópica rutinaria unas lesiones subretinianas blanco-amarillentas en la periferia media temporal superior de ambos ojos. Ecográficamente eran hiperecogénicas, situándose a nivel esclerocoroideo. Se realizó una tomografía axial computarizada que mostró calcificaciones esclerocoroideas posterolaterales. El estudio metabólico reveló una deficiencia severa de vitamina D sin otros hallazgos significativos. Discusión: Las calcificaciones esclerocoroideas son lesiones poco frecuentes que se producen como consecuencia del depósito de calcio a nivel de la esclera y la coroides. Tienen un aspecto clínico característico y en la mayor parte de los casos son idiopáticas. En ocasiones se asocian a enfermedades que cursan con alteraciones del metabolismo del calcio y fósforo, por lo que es necesario realizar un estudio metabólico completo. Se presenta un caso de calcificaciones esclerocoroideas bilaterales asociadas a una hipovitaminosis D de grado severo sin otros hallazgos metabólicos

CASE REPORT: A 69 year-old woman was referred for a routine visit, during which funduscopy revealed white-yellow subretinal lesions in the superotemporal mid-periphery of both eyes. A and B scan ultrasound showed hyperechogenic lesions located at scleral and choroidal level. Computed tomography revealed posterolateral sclerochoroidal calcifications. Metabolic studies showed a severe vitamin D deficiency with no other remarkable findings. Discussion: Sclerochoroidal calcifications are an infrequent finding that occur as a result of calcium deposit at scleral and choroidal level. They have a characteristic clinical picture and are idiopathic in most cases, but may be associated with some systemic diseases, such as calcium and phosphorous metabolic disorders; this fact warrants a thorough metabolic study. We report a case of bilateral sclerochoroidal calcifications associated with severe vitamin D deficiency with no other significant metabolic findings

[Sclerochoroidal calcification associated with hypovitaminosis D]. / Calcificaciones esclerocoroideas asociadas a hipovitaminosis D.

CASE REPORT: A 69 year-old woman was referred for a routine visit, during which funduscopy revealed white-yellow subretinal lesions in the superotemporal mid-periphery of both eyes. A and B scan ultrasound showed hyperechogenic lesions located at scleral and choroidal level. Computed tomography revealed posterolateral sclerochoroidal calcifications. Metabolic studies showed a severe vitamin D deficiency with no other remarkable findings. DISCUSSION: Sclerochoroidal calcifications are an infrequent finding that occur as a result of calcium deposit at scleral and choroidal level. They have a characteristic clinical picture and are idiopathic in most cases, but may be associated with some systemic diseases, such as calcium and phosphorous metabolic disorders; this fact warrants a thorough metabolic study. We report a case of bilateral sclerochoroidal calcifications associated with severe vitamin D deficiency with no other significant metabolic findings.

[Sympathetic ophthalmia post-vitrectomy following trauma and perfluorocarbon liquid tamponade]. / Oftalmía simpática postvitrectomía tras traumatismo y taponamiento con perfluorocarbono líquido.

CASE REPORT: We report a case of sympathetic ophthalmia (SO) developed after blunt trauma and vitrectomy (complicated with a massive suprachoroidal hemorrhage) using perfluorocarbon liquid (PFCL) for tamponade. DISCUSSION: The presentation of SO in a vitrectomized patient after severe blunt trauma with extended intra-ocular tamponade with PFCL could support the hypothesis that chronic inflammation caused by PFCL could have contributed to the development of SO. Nevertheless, there are other possible causal factors such as the trauma, the vitrectomy itself or the choroidal detachment with possible uveal incarceration at wound sites.

Oftalmía simpática postvitrectomía tras traumatismo y taponamiento con perfluorocarbono líquido / Sympathetic ophthalmia post-vitrectomy following trauma and perfluorocarbon liquid tamponade

Caso clínico: Se describe un caso de oftalmía simpática (OS) desarrollado tras un traumatismo contuso tratado mediante vitrectomía (que se complicó con una hemorragia supracoroidea masiva) y taponamiento con perfluorocarbono líquido (PFCL). Discusión: La presentación de OS en un paciente vitrectomizado tras un traumatismo ocular contuso grave con taponamiento intra-ocular prolongado con PFCL permitiría plantear la hipótesis de que la reacción inflamatoria crónica producida por estos compuestos podría haber colaborado en el desarrollo de la OS. Sin embargo, existen otros posibles factores causales como el propio traumatismo, la vitrectomía en sí o el desprendimiento de coroides con posible incarceración de tejido uveal en las incisiones(AU)

Case report: We report a case of sympathetic ophthalmia (SO) developed after blunt trauma and vitrectomy (complicated with a massive suprachoroidal hemorrhage) using perfluorocarbon liquid (PFCL) for tamponade. Discussion: The presentation of SO in a vitrectomized patient after severe blunt trauma with extended intra-ocular tamponade with PFCL could support the hypothesis that chronic inflammation caused by PFCL could have contributed to the development of SO. Nevertheless, there are other possible causal factors such as the trauma, the vitrectomy itself or the choroidal detachment with possible uveal incarceration at wound sites(AU)

[Experimental study on usefulness of silicone-fluorsilicone copolymer oil (SiFO) in vitreoretinal surgery]. / Estudio experimental sobre la utilidad del aceite de copolímero de silicona-fluorsilicona (SiFO) en la cirugía vitreorretiniana.

PURPOSE: To evaluate the usefulness of silicone-fluorsilicone copolymer oil (SiFO) as an intraoperative tool and a vitreous substitute in vitreoretinal surgery. METHODS: Handling properties of SiFO were tested and compared with those of perfluorooctane (PFO). The transparency of both substances was measured by spectrophotometry and subjectively assessed. Their tendency to dispersion was observed during injection in balanced saline solution (BSS) and after mechanized and manual shaking. Ease of injection and aspiration through small-gauge instruments was evaluated. Ocular tolerance to SiFO and PFO was studied after intravitreal injection in rabbit eyes: intraocular pressure, anterior segment inflammatory response and dispersion were evaluated, and a histopathological study was performed. RESULTS: Injection and aspiration of SiFO were more difficult than those of PFO because of its higher viscosity. PFO dispersed progressively into small droplets as early as two days after intravitreal injection, whereas SiFO remained as a single bubble for 14 days. Histopathologically both substances induced an inflammatory response over the inferior retina, with microvacuolated macrophages and foreign body giant cells, which were larger in eyes wearing SiFO. CONCLUSIONS: SiFO may be useful as an intraoperative tool, although its main drawback is a more difficult injection and aspiration compared to PFO. It has been well tolerated as a short-term vitreous substitute, but further clinical studies are needed.

[Corneal epithelial complications after vitrectomy: a retrospective study]. / Complicaciones corneales epiteliales de las vitrectomías: estudio retrospectivo.

PURPOSE: To establish the incidence, evolution and final visual outcome of corneal epithelial complications after vitrectomy in a consecutive series performed throughout a period of one year. METHODS: 195 consecutive medical records of patients vitrectomized in 2001 have been retrospectively reviewed. Patients were clinically evaluated the day after vitrectomy, during the first week, and then weekly for 3 months (minimum follow-up). Functional results have been established at the end of this period. RESULTS: 12 out of 195 eyes developed corneal epithelial complications after surgery (6.1%). Eight cases were diagnosed of persistent epithelial defect (4.1%), and four cases (2%) of necrotizing herpetic keratitis. Six out of 12 were diabetic. Corneal epithelial complications affected 10.5% of diabetic and 4.3% of non-diabetic patients (p=0.10). The majority of persistent epithelial defects healed without sequelae in less than two months. Herpetic keratitis required between 3 to 4 months to heal and caused corneal scarring in all cases. CONCLUSIONS: Persistent corneal epithelial defects after vitrectomy are a relatively frequent complication, mainly in diabetic patients. Recurrence of herpetic keratitis must also be kept in mind. This finding has not been previously reported and needs further studies.

[Iatrogenic retinal breaks during vitrectomy: retrospective study]. / Roturas retinianas iatrogénicas en las vitrectomías: estudio retrospectivo.

PURPOSE: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management. METHODS: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases. RESULTS: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached. CONCLUSIONS: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy.

Roturas retinianas iatrogénicas en las vitrectomías: estudio retrospectivo / Iatrogenic retinal breaks during vitrectomy: retrospective study

Objetivo: Establecer la incidencia y las características de las roturas retinianas iatrogénicas que se han producido en vitrectomías y proponer un protocolo de actuación. Métodos: Se han revisado de forma retrospectiva 195 vitrectomías consecutivas realizadas en 2001. El seguimiento mínimo de todos los casos ha sido de 3 meses. Resultados: Se han detectado roturas retinianas en 13 pacientes (6,6 por ciento). El tipo más frecuente han sido las roturas periféricas con 8 casos. Hubo 4 casos de roturas posteriores y una diálisis retiniana. En 4 casos se produjo más de una rotura. En 9 casos (70 por ciento) la vitrectomía se indicó por lesiones derivadas de la diabetes mellitus. La mayoría (12) fueron detectadas durante la intervención y todas tratadas con endoláser y/o frío (3 casos de localización inferior). En el postoperatorio, 7 casos (54 por ciento) desarrollaron un desprendimiento de retina de los que 2 pudieron ser reaplicados. Conclusiones: De las roturas retinianas iatrogénicas producidas por la vitrectomía, los desgarros periféricos son un poco más frecuentes que los producidos en polo posterior. Son más frecuentes en diabéticos y tienen mal pronóstico ya que evolucionan con frecuencia a un desprendimiento de retina a pesar del tratamiento con endoláser o frío (AU)

Purpose: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management. Methods: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases. Results: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached. Conclusions: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy (AU)